昂丹司琼联合利多卡因用于静脉局部麻醉。

Department of Anaesthesiology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

Eur J Anaesthesiol. 2009 Dec;26(12):1032-6. doi: 10.1097/EJA.0b013e3283317d93.

BACKGROUND AND OBJECTIVE

The aim of this study was to evaluate the effect of ondansetron when added to lidocaine for intravenous regional anaesthesia (IVRA).

METHODS

Thirty patients undergoing hand surgery were randomly assigned to two groups. IVRA was achieved with 3 mg kg lidocaine 2% w/v diluted with saline to a total volume of 40 ml in the control group or with 4 mg ondansetron 2 mg ml plus 3 mg kg lidocaine 2% w/v diluted with saline to a total volume of 40 ml in the ondansetron group. Sensory and motor block onset and recovery times, tourniquet pain score according to a visual analogue scale (VAS), intraoperative analgesic requirements and anaesthesia quality were recorded. Postoperative VAS pain score, time to first analgesic requirements and total diclofenac consumption in the first 24 h were noted.

RESULTS

Onset times were slightly but significantly shorter [1.4 min (95% confidence interval (CI) 0.5-2.3) and 1.5 min (95% CI 0.45-2.55)] and recovery times were slightly but significantly prolonged [2.6 min (95% CI 1.66-3.54) and 2.8 min (95% CI 1.83-3.78)] in patients receiving ondansetron. Tourniquet pain scores according to the VAS were slightly but significantly lower at 10, 15, 20 and 30 min, the time to intraoperative analgesic rescue was prolonged (35.0 +/- 7.1 min vs. 18.9 +/- 8.9 min, P = 0.043), a significantly lower number of patients (2 vs. 9) required additional analgesic and significantly less supplemental fentanyl was given [0 microg (0-0) vs. 59 microg (0-76), P = 0.015] in the ondansetron group. First intake of analgesic intake was longer (172 +/- 51 vs. 85 +/- 35 min, P = 0.0001), number of patients (7 vs. 15) requiring postoperative diclofenac was significantly lower and diclofenac requirements [0 mg (0-75) vs. 75 mg (75-150), P = 0.002) was significantly lower in the ondansetron group. Postoperative VAS scores were lower for the first 4 h in the ondansetron group.

CONCLUSION

Addition of ondansetron to lidocaine may improve the quality of IVRA and prolong postoperative analgesia in patients undergoing hand surgery.

背景与目的

本研究旨在评估昂丹司琼在利多卡因静脉局部麻醉（IVRA）中的作用。

方法

30 名接受手部手术的患者随机分为两组。对照组给予 3 mg/kg 2%利多卡因生理盐水稀释至 40 ml，观察组给予 4 mg 昂丹司琼 2 mg/ml 加 3 mg/kg 2%利多卡因生理盐水稀释至 40 ml。记录感觉和运动阻滞起效和恢复时间、根据视觉模拟评分（VAS）评估止血带疼痛评分、术中镇痛需求和麻醉质量。记录术后 24 h 内 VAS 疼痛评分、首次镇痛需求时间和双氯芬酸总消耗量。

结果

观察组患者的起效时间略短但差异有统计学意义[1.4 min（95%置信区间（CI）0.5-2.3）和 1.5 min（95% CI 0.45-2.55）]，恢复时间略长[2.6 min（95% CI 1.66-3.54）和 2.8 min（95% CI 1.83-3.78）]。观察组患者在 VAS 评估的止血带疼痛评分在 10、15、20 和 30 min 时略低，术中镇痛补救时间延长（35.0 +/- 7.1 min 比 18.9 +/- 8.9 min，P = 0.043），需要额外镇痛的患者数量显著减少（2 比 9），给予的芬太尼补充剂显著减少[0 microg（0-0）比 59 microg（0-76），P = 0.015]。观察组患者首次镇痛时间更长（172 +/- 51 比 85 +/- 35 min，P = 0.0001），需要术后双氯芬酸的患者数量显著减少（7 比 15），双氯芬酸需求[0 mg（0-75）比 75 mg（75-150），P = 0.002]显著减少。观察组患者术后 4 h 内 VAS 评分较低。